Singapore's compulsory organ transplants

By Sebastien Berger, South East Asia Correspondent

12:01AM GMT 02 Mar 2007

As Sim Tee Hua lay on life support in a Singapore hospital, seven of his relatives knelt crying on the floor before the doctors, begging them not to remove his organs and give him a chance for a miracle recovery.

Their desperate pleas were to no avail and after police and hospital security staff were called in to restrain them, Mr Sim, 43, was rolled away to the operating theatre to expire.

"The hospital staff were running as they wheeled him out of the back door of the room," said Sim Chew Hiah, one of his sisters. "They were behaving like robbers."

The previously healthy lorry driver was already brain-dead after suffering a stroke at work, followed by a cerebral haemorrhage in Singapore General Hospital. The harvesting surgeons had waited for 24 hours, but although his family still clung to hopes that he could recover, Singaporean law assumes all citizens except Muslims are willing organ donors unless they have explicitly opted out.

As a way to tackle the perennial shortage of organs that all developed societies face it has proved effective - kidney transplant rates have tripled since the measure was brought in - but it is also a policy that exemplifies the authorities' paternalistic attitude towards the people.

Nonetheless the spectacle of a distraught family abasing themselves in a futile attempt to win an extra day's grace for their son and brother has triggered a rare debate in the city-state, with the letters pages of its newspapers filled with comments for and against.

"Tears would roll down from his eyes when we spoke to him, telling him not to give up," Mr Sim's brother Tee Yong, 49, told the New Paper.

"We know that medically a brain-dead person cannot wake up. But we did not want to give up hope. All we asked for is just one more day for a miracle to happen."

Justine Burley, a bio-ethicist at the National University of Singapore, said the opt-out policy on donation was "fundamentally a good idea" but allowances had to be made on a case-by-case basis and relatives' mental trauma taken into consideration.

"The spectre of family members down on their knees begging the doctors is almost too much to bear from a human standpoint," she said.

Singapore's media generally follow the government line, and the Today newspaper yesterday implicitly rebuked the relatives, referring to the harvest taking place "in spite of a ruckus created by his family members".

In an article headlined: "Postponement killed dreams of liver transplant patients" it quoted the health minister Khaw Boon Wan telling parliament that the single 24-hour delay they had been granted rendered Mr Sim's liver unusable, although his kidneys and corneas had been transplanted.

"We try our best to be compassionate, but the bottom line is we need to be firm with this opting-out policy and respect the wishes of the dead," he said. "People have a choice to opt out and if they don't, we assume that they must have no objections."

Economically Singapore is a huge success, and Lee Wei Ling, a doctor and the daughter of the country's founding father Lee Kuan Yew, called for the buying and selling of organs to be legalised.

"Organ trading is frowned upon and usually not allowed in countries where political correctness reigns," she wrote. "If monetary incentive makes a potential living donor more willing to save another life, what is wrong in allowing that?" Her suggestion was described as "wrong" by Alastair Campbell, the Chen Su Lan professor of medical ethics at the National University of Singapore, because of the "inevitable exploitation that would be involved".

"The sellers are always going to be the desperate poor," he said, adding that "to trade the human body as some sort of material possession like a car or house" was crossing an unacceptable line.

Mr Sim's parents have been offered reduced hospital fees for five years, and the family have been sent a letter thanking them for their "generous organ donation".